Oral & Maxillofacial Surgery

Services

Sleep Apnea (and Snoring Surgery)

In a perfect world, everyone would sleep soundly and wake rested; but for those suffering with obstructive sleep apnea (OSA), seven to eight hours of uninterrupted sleep is just a dream. From excessive daytime sleepiness and loss of concentration to depression and cardiovascular problems, sleep apnea is a serious medical condition that can be successfully treated by a team of highly skilled surgeons in the Department of Oral and Maxillofacial Surgery (OMFS) at Boston Medical Center.

What is OSA?

During sleep, the upper airway is obstructed by excess tissue in the back of the throat, large tonsils and/or a large tongue. The obstruction causes the diaphragm and chest muscles to work harder than normal. These conditions cause a person’s breathing to become interrupted because less air than normal is inhaled. Taking in less air causes a person to wake up, which restarts the normal breathing process.

Those who are diagnosed with sleep apnea generally have 30 of these interruptions during a seven-hour sleep period. In severe cases, breathing may stop for as long as 60-90 seconds and happen up to 500 times per night.

OSA Symptoms

Those who have OSA are often unaware of their condition and think they sleep well because they do not remember waking up. The symptoms that usually lead people to seek help are daytime drowsiness or complaints of snoring and breathing problems observed by a partner. OSA symptoms may include:

Snoring with pauses in breathing (apnea)

Excessive daytime drowsiness

Gasping or choking during sleep

Restless sleep

Problem with mental function

Poor judgment/can’t focus

Memory loss

Quick to anger

High blood pressure

Nighttime chest pain

Depression

Problem with excess weight

Large neck (>17” around in men, >16” around in women)

Airway crowding

Morning headaches

Reduced libido

Frequent trips to the bathroom at night

Diagnosing Sleep Apnea

If you have several of these symptoms, you should talk to an oral and maxillofacial surgeon (OMS) for a complete examination and an accurate diagnosis.

Treatment of Sleep Apnea

If you are diagnosed with sleep apnea, your OMS will help you decide which treatment is best for you. Depending on whether your OSA is mild, moderate or severe, this can range from lifestyle modification to oral appliances to a C-PAP device which is a machine that helps a person breathe more easily during sleep.

Lifestyle ModificationIf a patient is are diagnosed with mild sleep apnea, your doctor may suggest you employ the non-medical treatments recommended to reduce snoring including weight loss or changing your sleeping position to your side. In mild cases, these practical interventions may improve or even cure snoring and sleep apnea.

Oral AppliancesFor patients who have moderate sleep apnea, or are unable to use a C-PAP device, recent studies have shown that an oral appliance can be an effective treatment. The oral appliance is a molded device that is placed in the mouth at night to position the lower jaw and bring the tongue forward, elevating the soft palate while keeping the tongue from falling back in the airway and blocking breathing. Patients using an oral appliance should have regular follow-up office visits to check it is working correctly and to make sure their symptoms are not getting worse. If you are interested in an oral appliance, please call (617) 638-4350 to schedule an appointment.

C-PAP (Continuous Positive Airway Pressure) and Bi-PAP (Bi-Level) DevicesA C-PAP device is an effective treatment for patients with moderate OSA and the first-line treatment for those diagnosed with severe sleep apnea. Through a specially fitted mask that fits over the patient’s nose, the C-PAP’s constant, prescribed flow of pressured air prevents the airway (or throat) from collapsing. In some cases a Bi-PAP device, which blows air at two different pressures, may be used. If you stop using the C-PAP or Bi-PAP, your symptoms will return. Although C-PAP and Bi-PAP are often the first treatments of choice, they may be difficult for some patients to accept and use. If you find you are unable to use these devices, do not stop without first talking to your doctor.

Jaw Surgery – Maxillomandibular AdvancementAppliances and C-PAP are treatments, but not cures. At BMC, we are proud to provide patients with curative options. Recommended for patients age 16 and above, BMC surgeons perform the highest number of such surgeries in New England. Now with quicker operating times, shorter hospital stays and fewer complications, modern day jaw surgery is a viable option for patients when C-PAP treatment fails to relieve symptoms or is not well tolerated. To find out if you are a good candidate for surgery, you will have a series of appointments and tests with our surgeons. These include and evaluation where the physician locates the obstruction by assessing your facial structures including the nose, throat, jaws, palate and chin areas. Additional 3D cat scans, computer tracings and simulations are also done and together form an individualized treatment plan.

Once those are complete, your surgery will be scheduled. Maxillomandibular Advancement, or Sleep Apnea Jaw Surgery, is a procedure that surgically moves the upper and lower jaws forward. The bones are surgically moved forward, as are the soft tissues of the tongue and palate. This causes the upper airway to open, which makes normal breathing possible during sleep.

The hospital stay is typically two to three days with the first two weeks following surgery requiring limited activity. Normal life can resume within two to four weeks, barring very strenuous tasks like the gym and contact sports.